Induction of Labor with PGE2 after One Previous Cesarean Section: 18 Years Experience in a University Hospital

Objective: To review the outcome of prostaglandin induction of labor in term pregnant women with previous one ce-sarean section compared to those without previous Cesarean section. Design: 18 years retrospective review of hospital records and case note review of index cases. Setting: University hospital. Population: Three hundred and twenty two women who had their labor induced with prostaglandin E2. One hundred and sixty one women had one previous Ce-sarean section. Methods: This study was conducted at King Fahad University Hospital, University of Dammam. It is a tertiary referral center with approximately 2300 births per year. We searched the hospital's records of deliveries from January 1992 to December 2009 and reviewed all indications and outcomes of prostaglandin induction of labor in women with one previous Cesarean section. The control group was composed of women who had their labor induced with prostaglandin but without previous Cesarean section. Main outcome measures: Labor outcome and uterine rup-ture Results: Three hundred and twenty two women were included. All received prostaglandin E2 for induction of labor. One hundred and sixty one women had one previous Cesarean section (study group) and the rest had no previous Ce-sarean section (control group). There was no difference in the rate of vaginal delivery between study and control group, 68.3% and 79.5% (p value 0.3), respectively. The rate of uterine rupture was 30 times higher in study group (2.5% Vs 0.033%). Conclusion: In women with one previous Cesarean section, induction of labor with prostaglandin leads to comparable rate of vaginal delivery similar to those without prior Cesarean section but with relatively high risk of uter-ine rupture.